Provider Demographics
NPI:1679274187
Name:PIERCE, VICKI TERESA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:TERESA
Last Name:PIERCE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-4031
Mailing Address - Country:US
Mailing Address - Phone:478-918-3245
Mailing Address - Fax:
Practice Address - Street 1:209 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-4031
Practice Address - Country:US
Practice Address - Phone:478-918-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily